Thinking Disorders: Schizophrenia - Essay Example

 Introduction Schizophrenia, the most common psychotic disorder, refers to a thinking disorder whereby an individual’s ability to communicate, ability to recognize reality, his/her judgment, thinking process, as well as his/her emotional responses deteriorate greatly in such a way that there is serious impairment of his/her functioning (Birchwood, Birchwood & Jackson, 2001). Tsuang, Faraone & Glatt (2011) define schizophrenia as a disabling illness in which the affected individuals experience altered behaviors, thoughts, perceptions and emotions. The term schizophrenia was initially made up by Eugen Bleuler in the year 1911. Apparently, the social as well as psychological functioning of a person suffering from schizophrenia undergoes major changes, which are permanent or episodic in most cases. These changes can sometimes be transient for some people (Birchwood, Birchwood & Jackson, 2001). Tsuang, Faraone & Glatt (2011) further explain that as a mental disorder, schizophrenia has numerous consequences for the society, the affected persons, as well as their families. The affected persons may display many disruptions in their behaviors, normal thought processes, emotions, ability to hear, see, and to process information from the world around them. The interruption of such basic life aspects can be crippling for many affected persons, culminating into a lifetime of periodic hospitalizations, disability, and a disruption of social and family relationships stemming from the affected person’s communication inability and alienation, which may alternate with short periods of unruly behavior. The stigma of mental illness and the strain of taking care of a mentally ill family member can exacerbate the withdrawal of a person suffering from schizophrenia (Tsuang, Faraone & Glatt, 2011). Types of schizophrenia Prior to understanding much details about schizophrenia, a professor by the name Timothy Crow, upon observing the variability in both behavioral symptomatology and brain abnormality in schizophrenic patients, made a proposal of two discrete pathological syndromes in schizophrenia namely type I (equivalent to acute schizophrenia) and type II (equivalent to chronic schizophrenia). Type I syndrome is characterized by positive symptoms comprising behavioral excess, for example hallucinations and delusions, and is hypothesized to emanate from a dopaminergic dysfunction. Type I schizophrenics are expected to respond to neuroleptic drugs more that type II schizophrenics. On the other hand, negative symptoms such as poverty of speech and flattened affect characterize type II syndrome. Poor responses to antipsychotic drugs as well as brain structural abnormalities are typical to type II syndrome (Kolb & Whishaw, 2008). Today, more studies on schizophrenia have been conducted, and are still ongoing. Miller & Mason (2002) point out that there are five recognized major subtypes of schizophrenia including paranoid, catatonic, disorganized, residual and undifferentiated. All five subgroups have particular characteristics that are unique to it. The following is a description of each of these schizophrenia subtypes. Paranoid schizophrenia The hallmark of this kind of schizophrenia is a preoccupation with either one or numerous delusions or unrelenting auditory hallucinations. Although other delusions may occur, paranoid delusions are normally grandiose or persecutory in nature. In addition to these features, a patient suffering from paranoid schizophrenia may harbor a sense of unrelenting suspicion and may seem guarded, tense and reserved to a point of being vague or even mute. Although patients suffering from paranoid schizophrenia universally exhibits hallucinations and/or delusions, they may also exhibit, in varying degrees, other clinical features including aggression, hostility and even violence. On neuropsychological tests, they show only mild impairments if any, and compared to patients with other subtypes of schizophrenia, their long-term prognosis is characteristically better (Tsuang, Faraone and Glatt, 2011). Disorganized schizophrenia Miller & Mason (2002) explain that confused speech, flat or unsuitable affect, and disorganized behavior (as the name suggests) characterizes this type of schizophrenia. Disorganization of the thought process is the predominant feature in this subtype while delusions and hallucinations are less pronounced. Individuals with this type of schizophrenia may exhibit considerable impairments in their ability to maintain their daily living activities including but not limited to such activities as bathing, dressing or brushing teeth. Frequently, individuals’ emotional processes undergo impairment. For instance, they may fail to demonstrate normal emotional responses in circumstances that induce such responses in healthy individuals, a symptom that mental health professionals refer to as flat or blunted affect. Additionally, their ability to communicate efficiently may undergo considerable impairment, and their speech may sometimes become nearly inexplicable owing to their disorganized thinking. Instead of characterizing their speech with difficulties of articulation or annunciation in such cases, problems with words’ usage and ordering in conversational statements characterize it (Siegel, Ralph & Ralph 2010). Catatonic Schizophrenia The predominant clinical feature that characterizes this subtype of schizophrenia is disturbances in movement. Individuals with this subtype may exhibit a striking activity decline to the extent of stopping of voluntary movement, as in catatonic stupor. On the other hand, they may have a dramatic increase in activity, a state referred to as catatonic excitement. They may also exhibit stereotypic behavior (characterized by repetitive performance of actions that appear comparatively purposeless), usually to the exclusion of participation in any productive endeavor. Patients may exhibit stillness or may resist making any attempts to change their appearance and may therefore, at times for extended periods of time, retain a pose in which someone positions them, a symptom that is sometimes termed as waxy flexibility. Additionally, these patients may willingly assume atypical body postures, or exhibit unusual limb movements or facial contortions. Echolalia (parrot-like repeating of what other individuals say) and echopraxia (mimicking another person’s movements) are other symptoms associated with catatonic schizophrenia (Miller & Mason, 2002) and (Tsuang, Faraone & Glatt, 2011). Undifferentiated Schizophrenia In case a patient manifests symptoms of schizophrenia that are not specific enough or adequately formed to allow categorization of the illness into one of the other subtypes of schizophrenia, then the undifferentiated subtype is diagnosed. While some individuals with this subtype will manifest remarkably stable symptoms over time that still fail to fit any of the typical pictures of schizophrenia subtypes, others may exhibit symptoms that fluctuate at varying points in time ensuing uncertainty as to their exact subtype classification. In either of the aforementioned instances, the best description for the mixed clinical syndrome is diagnosing undifferentiated schizophrenia (Siegel, Ralph & Ralph 2010). Residual Schizophrenia In a situation where a patient no longer exhibits prominent schizophrenic symptoms, residual schizophrenia is diagnosed. This subtype is therefore characterized by a general decrease in severity of schizophrenic symptoms. In other words, although delusions, hallucinations and idiosyncratic behaviors may still be evident in the patient, compared to the acute phase of the illness, their manifestations are considerably diminished (Tsuang, Faraone & Glatt, 2011) and (Siegel, Ralph & Ralph 2010). Causes of schizophrenia Experts believe that several factors bring about schizophrenia. The first factor is genes and environment. For a long time, scientists have known schizophrenia to run in families. Although the disorder arises in 1% of the general population, it occurs in 10% of individuals whose first-degree relation such as a parent, sister or brother had/has the disorder. Persons whose second-degree relatives such as grandparents, cousins, aunts or uncles have/had the illness are also more likely to develop schizophrenia compared to the general population. The risk is greatest for an identical twin of an individual suffering from schizophrenia (40 – 65%) (Cardno & Gottesman, 2000). People inherit their genes from both parents. Scientists link several genes with a greater risk of schizophrenia, but they point out that no gene brings about the disease by itself (Harrison & Weinberger, 2005). In effect, recent research indicates that persons suffering from schizophrenia have a tendency of having increased rates of unusual genetic mutations. These genetic disparities involve numerous different genes and most likely disrupt the development of the brain (Walsh, et al., 2008). According to other recent studies, schizophrenia may develop in part following a malfunctioning of a certain gene that is vital in the making of vital brain chemicals. This hitch may have an effect on the part of the brain that is concerned with the development of higher functioning skills (Huang, et al., 2007). It is important to note that it most likely takes more than genes to bring about the disorder. According to scientists, for schizophrenia to arise, there must be interactions between genes and the environment. Various environmental factors such as problems during birth, malnutrition before birth, exposure to viruses and other unknown psychosocial factors must exist. Scientists also attribute the development of schizophrenia to different brain chemistry and structure. They think that a disparity in the brain’s interrelated, intricate chemical reactions involving the neurotransmitters (substances that permit the communication of brain cells) glutamate and dopamine, and perhaps others, contributes to the development of schizophrenia. Scientists have discovered that in small ways, compared to brains of healthy individuals, the brains of individuals suffering from schizophrenia appear different. For instance, their ventricles are sometimes larger and their brains also have a tendency of having less gray matter, in addition, some brain areas may have more or less activity. Experts also believe that problems at some stage in the development of the brain prior to birth may bring about defective connections. A person may not exhibit this problem until puberty, a period during which the brain goes through key changes, which may trigger psychotic signs (Mueser & McGurk, 2004). Symptoms of Schizophrenia One symptom of schizophrenia is delusions. These are false personal beliefs concerning the world, which embody beliefs that the cultural peer group of the individual do not share. Delusions in schizophrenia are generally of different types. The first type is known as delusions of identity whereby a person may believe that he/she has lost his/her sense of purpose or identity and that he/she possesses abilities/powers out of the ordinary. The second type is known as delusions of control or influence whereby a person may feel and believe that some external force control or influence his/her behavior. In the third type, which is known as delusion of persecution, an individual may hold the belief that he/she is being persecuted, watched or followed in some way. The fourth type of delusions is delusions of reference whereby a person may hold the belief that other people’s remarks are directed to them (Birchwood, Birchwood & Jackson, 2001). Another symptom of schizophrenia is auditory hallucinations. These are false perceptions mostly in the form of voices or noises conversing about the individual or commentating on his/her actions or thoughts in the third person. A person with schizophrenia also develops thinking disorders – he/she may feel as if thoughts have been withdrawn from or put into his/her mind. At times, the individual may have the feeling that his/her thought are being broadcast in such a way that other people are able to hear them, often over long distances. As discussed earlier, another symptom that is common in persons suffering from schizophrenia is experiences of control. In this case, the individual feels like an alien power or force is controlling him/her. He/she may also feel as if an external force has entered his/her body or mind. This is usually interpreted as the presence of implanted radio transmitters, spirits or X-Rays (Birchwood, Birchwood & Jackson, 2001). Another main symptom of schizophrenia has to do with volitional and emotional changes. The person’s feelings as well as emotions become less clear (blurred) and they are mostly expressed as being ‘flat.’ He/she may also experience a loss of energy or initiative. These changes are at times known as ‘negative symptoms (Birchwood, Birchwood & Jackson, 2001). Tsuang, Faraone and Glatt (2011) explain it this way: negative symptoms of schizophrenia are point to important behaviors, which are detached from the behavioural repertoire. These negative symptoms denote lack of feelings and emotions loss of normal behaviors as well as blunted effect. These include speech disruption or poverty (alogia), unwillingness to interact with the world (avolition), affective blunting/flattening (lack of the ability to express emotions), the preference for isolation (asociality), lack of the ability to experience pleasure (anhedonia), and catatonia (a group of four motor and cognitive symptoms). Negative symptoms prevail during the prodromal and residual stages of the disorder. While the prodromal stage comes before the first active phase, the residual stage comes after the active phase. Tsuang, Faraone and Glatt (2011) also define positive symptoms as symptoms that show up as unseen behaviors in human activities’ normal repertoire. These symptoms prevail during the disorder’s active phase, when the patient is most disruptive and disturbed. During the active phase, the affected individual is most likely to be referred for care or hospitalized since typically; he/she will be saying or doing things that worry persons around them. They classify delusions and hallucinations as positive symptoms of schizophrenia, which designate the production of strange phenomena. They also explain that typically, compared to positive symptoms, negative symptoms are less identified and treated; they are less disruptive to others although they bring about significant disability to the affected persons. Diagnosis of Schizophrenia Prior to arriving at a diagnosis of schizophrenia, doctors must ensure that they undertake a thorough psychiatric evaluation, which includes a physical examination, a medical evaluation, an examination of mental status, as well as suitable laboratory tests. Additionally, they should carry out an evaluation of a full history of the illness, which includes any variations in thinking, mood, behavior, movement and sensory perceptions that the patient or their family and friends see. As a rule, it is obligatory to exclude other diagnoses – considering that other psychotic disorders such as substance abuse, major depression, bipolar disorder and other medical illnesses demonstrate numerous symptoms akin to those of schizophrenia; doctors must eliminate these possibilities prior to diagnosing schizoaffective disorder or schizophrenia (Miller & Mason, 2002). Gilmore (2010) explains that the diagnosis of this disorder is normally done with the aid of a longitudinal examination of the individual. This implies that while making a diagnosis, the structure of the illness is as imperative as its content. Currently, the diagnosis of schizophrenia cannot be based on the results of lab assessment or a diagnostic test since the many theories that abound with regard to its causes have not been validated. The modern diagnosis for this disorder is instead based on descriptive behavior patterns as well as dependably accessible psychopathology. Beginning the year 1980, major mental illnesses’ definitions are catalogued in the form of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) as well as the International Classification of Diseases (ICD) of World Health Organization in other nations. These definitions are occasionally revised to reflect contemporary conceptualizations of the distinctness or relatedness of certain illnesses as compared to others, or to reflect advancements in knowledge. Some diagnoses are added from one edition to the other, some are revised, while others disappear altogether, and are listed or reinstated under others afterward (Siegel, Ralph & Ralph 2010). As defined by majority of the most recent DSM version, schizophrenia’s diagnostic criteria are aggregated into 6 sets that are labeled A-F. Over a century ago, clinician Emil Kraepelin identified massive disruption in cognition and/or perception as the core features of this disorder. Diagnostic criterion A requires the presence of these core features in some form. Therefore, criterion A is considered to be met in case of an individual exhibiting particular kinds of thought disorders, auditory hallucinations, catatonia, delusions, or negative symptoms. Criteria B and C reflect the belief of clinician Kraepelin that a chronic and progressively worsening course characterizes schizophrenia. These two criteria are considered as met if a patient exhibits an apparent indication of deterioration in occupational or social functioning and for at least six months, the patient demonstrates ongoing illness signs (Tsuang, Faraone and Glatt, 2011). Criterion D aids in the differentiation of schizophrenia from full maniac or depressive disorders with psychotic features thereby ensuring that schizophrenia diagnosis represents a comparatively uniform set of patients who exhibit analogous features. In case a patient exhibits a full maniac or depressive syndrome, he or she would not receive a schizophrenia diagnosis, except when the development of mood disturbance took place after schizophrenia syndrome’s active phase, or in relation to it, it was brief. Criteria E and F necessitates that a general medical condition, a pervasive development disorder, or substance use be not used to account better for the illness. The reasoning behind the necessity of these exclusions is that there are other known conditions that mimic schizophrenia’s signs and symptoms (Siegel, Ralph & Ralph 2010). The merit of appropriate application of these diagnosis criteria is that the ability to rely on noticeable disturbances diminishes inferences thereby increasing the probability that independent clinicians can efficiently diagnose the same patient with the same disorder. This scheme therefore leaves no room for speculation with regard to the potential causal factors, although besides evaluating the criteria met in a particular case, sound clinical judgment is paramount. This is owing to the fact that with structured criteria, the evaluation of the presence or absence of symptoms within a particular, well-defined criterion necessitates the application of clinical judgment. The main focus of the structured diagnostic criteria in the DSM is mainly on the data collection portion of the diagnostic process (Tsuang, Faraone & Glatt, 2011). Treatment of schizophrenia Given that the causes of schizophrenia still remain unknown, treatments usually focus on purging the symptoms of the illness for instance, delusions and hallucinations. Treatments include a variety of psychosocial treatments and antipsychotic medications. Antipsychotic medications have been in existence from mid 1950’s. The older medications are known as typical or conventional antipsychotics. Some typical medications that are commonly in use include: Fluphenazine (Prolixin), Chlorpromazine (Thorazine), Haloperidol (Haldol) and Perphenazine (Trilafon, Etrafon). New antipsychotic medications (known as atypical or second generation antipsychotic medications) came into being in the 1990’s. Clozapine (Clozaril) is one example of these atypical drugs – it treats psychotic symptoms, breaks with reality and hallucinations. Although it is effective, clozapine can at times bring about a serious problem known as agranulocytosis (loss of infection-fighting white blood cells). It is therefore vital for patients who use this drug to have their white blood cell counts tested weekly or fortnightly. Together with blood tests’ cost, this problem makes clozapine treatment difficult for many individuals. Nevertheless, for individuals who do not respond to other antipsychotic drugs, clozapine is potentially useful (Gogtay & Rapoport, 2008). Other examples of atypical antipsychotics that do not cause agranulocytosis include: Aripiprazole (Abilify), Olanzapine (Zyprexa), Paliperidone (Invega), Risperidone (Risperdal) Ziprasidone (Geodon) and Quetiapine (Seroquel). The side effects of these medications include skin rashes; drowsiness; dizziness while changing positions; rapid heartbeat; blurred vision; sensitivity to the sun; side effects affecting physical movement for instance, tremors, rigidity, restlessness and persistent muscle spasms; and menstrual problems for women. Most of these side effects disappear a few days later and they are often managed effectively. Changes in the patient’s metabolism and major weight gain can also result from taking atypical antipsychotic drugs. This may add to the patient’s risk of getting high cholesterol as well as diabetes. It is therefore important for the physician to monitor the patient’s lipid and glucose levels as well as weight frequently (Lieberman, et al., 2005). Conclusion Seeing that schizophrenia is so severe and many individuals will suffer from it at some point in their lives, the disorder should be deemed as a major concern in public health (Tsuang, Faraone & Glatt, 2011). Consequently, although scientists have broadly learned about the disorder, they still have the challenge of researching more in order for them to help elucidate its development. As Gilmore (2010) points out, the best way of comprehending and preventing this disorder is by concentrating not on the genes or risk factors a lot but concentrating on the developmental route, which is the final ordinary pathway to the illness. It is vital for physicians to determine the way in which the recognized genetic as well as environmental risk factors tamper with regular developmental paths. Moreover, they should also have a clear understanding of the epochs of the development of the human brain that are imperative for synapse as well as circuit development. Also worth noting is the fact that although the cause of schizophrenia is not actually understood or known, it is possible to help the affected persons and they can live better lives than many do at present. These people should not be stigmatized, as is the case in many societies whereby they are censured to live in jails or in the streets. References Birchwood, M. J., Birchwood, M. & Jackson, C. (2001). Schizophrenia. Portland, OR: Psychology Press. Cardno, A. G. and Gottesman II, (2000). Twin Studies of Schizophrenia: From Bow-and-arrow Concordances to Star Wars Mx and Functional Genomics. American Journal of Medical Genetics, 97, 1, 12-17. Gilmore, J. H. (2010). Understanding What Causes Schizophrenia: A Developmental Perspective. American Journal of Psychiatry, 167, 1, 8-10. Gogtay, N. and Rapoport, J. (2008). Clozapine Use in Children and Adolescents. Expert Opinion on Pharmacotherapy, 9, 3, 459-465. Harrison, P.J. and Weinberger, D.R. (2005). Schizophrenia Genes, Gene Expression, and Neuropathology: On the Matter of their Convergence. Journal of Molecular Psychiatry, 10, 1, 40-68. Huang, H.S. et al., (2007). Prefrontal Dysfunction in Schizophrenia Involves Missed-lineage Leukemia 1-regulated Histone Methylation at GABAergic Gene Promoters. Journal of Neuroscience, 27, 42, 11254-11262. Kolb, B. & Whishaw, I. Q. (2008). Fundamentals of Human Neuropsychology. London: Macmillan Publishers. Lieberman, et al., (2005). Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE). Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia. New England Journal of Medicine, 353, 12, 1209-1223. Miller, R. and Mason, S. E. (2002). Diagnosis : Schizophrenia: A Comprehensive Resource for Patients, Families, and Helping Professionals. New York: Columbia University Press. Mueser, K. T. and McGurk, S. R. (2004). Schizophrenia. Lancet, 363, 9426, 2063-2072. Siegel, S. J, Ralph, L. N. & Ralph, L. (2010). Demystifying Schizophrenia for the General Practitioner. Burlington, Massachusetts: Jones & Bartlett Learning. Tsuang, M. T., Faraone, S. V. and Glatt, S. J. (2011). Schizophrenia. New York: Oxford University Press. Walsh, T. et al., (2008). Rare Structural Variants Disrupt Multiple Genes in Neurodevelopmental Pathways in Schizophrenia. Science Journal, 320, 5875, 539-543. Read More